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General NPI Number Information
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NPI Number | 1023013638
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Entity Type | Individual
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Provider Name | MICHAEL L FESSENDEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/20/2005
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Last Update Date | 07/15/2007
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Provider Practice Location Address
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Address Line | 2003 W FULTON ST 3RD FLOOR
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City | CHICAGO
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State | IL
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Zip | 60612-2345
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Country | US
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Telephone | 773-292-4800
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Fax | 773-486-3548
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Provider Business Mailing Address
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Address Line | 2003 W FULTON ST 3RD FLOOR
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City | CHICAGO
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State | IL
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Zip | 60612-2345
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Country | US
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Telephone | 773-292-4800
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Fax | 773-486-3548
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2003016360
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 36118835
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D66365
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 43269-020
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License Number State | WI
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 8219
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License Number State | ND
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